Healthcare Provider Details

I. General information

NPI: 1851496715
Provider Name (Legal Business Name): AAAIP PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12510 QUEENS BLVD
KEW GARDENS NY
11415-1519
US

IV. Provider business mailing address

12510 QUEENS BLVD
KEW GARDENS NY
11415-1519
US

V. Phone/Fax

Practice location:
  • Phone: 718-520-3460
  • Fax: 718-520-3462
Mailing address:
  • Phone: 718-520-3460
  • Fax: 718-520-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number027934
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PETER NIYAZOV
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 718-520-3460